The article presents the modern view on the problem of biliopancreatic and duodenal tumor invasion into the main blood vessels on the example of successful treatment of a patient with recurrent gastrointestinal tumor. The patient received pancreatoduodenal resection (PDR) with resection of the inferior vena cava and right ureter allowing achieving R0 resection. Neoadjuvant imatinib contributed to making the tumor resectable. PDR with resection of the main vessels performed by an experienced multidisciplinary surgical team including surgical oncologists and vascular surgeons, supported by an appropriate anesthesia and drugs, is realizable and justified in locally advanced tumors. These interventions are recommended for patients with malignant tumors (gastrointestinal stromal tumors, neuroendocrine tumors) in which pre- and postoperative chemotherapy, including targeted therapy, allows making the disease controllable.